Healthcare Provider Details

I. General information

NPI: 1629010236
Provider Name (Legal Business Name): WILLIAM K. SHERWIN MD PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BALA PLAZA SUITE 620
BALA CYNWYD PA
19004
US

IV. Provider business mailing address

1 BALA PLAZA SUITE 620
BALA CYNWYD PA
19004
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-3300
  • Fax: 610-664-1151
Mailing address:
  • Phone: 610-664-3300
  • Fax: 610-664-1151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD018002E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD018002E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberMD018002E
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD018002E
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD018002E
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD018002E
License Number StatePA

VIII. Authorized Official

Name: DR. MARY E. GRIFFIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 610-664-3300